Estimating the cost-effectiveness of tumor treating fields for locally advanced pancreatic cancer patients

BACKGROUND: Locally advanced pancreatic cancer (LAPC) is associated with limited survival, high symptom burden, and few therapeutic innovations. The PANOVA-3 trial evaluated Tumor Treating Fields (TTFields) therapy applied with gemcitabine plus nab-paclitaxel (GnP) for first-line treatment of LAPC, demonstrating improved overall survival (OS), distant progression-free survival (PFS), and time to pain progression. We conducted a cost-utility analysis to evaluate the economic value of TTFields + GnP relative to GnP alone. METHODS: A partitioned survival model was developed using trial-based Kaplan-Meier curves for OS, distant progression-PFS, and time to pain progression. Model inputs reflected the intent-to-treat (ITT) population from PANOVA-3, with health utilities, resource use, and costs obtained from published U.S. sources. Disutility for pain was applied during time after pain worsening to capture quality-of-life decrement. Costs and outcomes were discounted at 3% annually, and analyses were conducted from a U.S. payer perspective. Deterministic, probabilistic, and scenario analyses explored uncertainty in key assumptions and model structure. RESULTS: TTFields + GnP increased discounted lifetime costs to $351,400 vs. $220,000 for GnP alone, with an incremental gain of 0.34 QALYs and an ICER of $387,300 per QALY. Approximately 0.03 QALYs were attributable to reduced time lived with pain. Sensitivity analyses identified TTFields therapy cost and treatment duration as primary drivers of the ICER. Scenario analyses produced ICERs ranging from $391,800 to $547,200 per QALY. CONCLUSIONS: TTFields + GnP improves survival and delays pain progression in LAPC, generating measurable gains in quality-adjusted survival. Resulting ICERs should be interpreted in the context of a disease with high unmet need, poor prognosis, and limited therapeutic options; factors that support a broader assessment of value beyond conventional cost-effectiveness thresholds. The multidimensional benefits observed, including quality-of-life gains, reinforce the case for TTFields therapy in LAPC and highlight the importance of incorporating such endpoints into economic evaluations of late-stage cancers.